When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress

Abstract

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for.

Risk factors for 2‐year mortality in patients with prolonged disorders of consciousness: An international multicentre study

“…Patients in MCS and, less frequently, those in VS/UWS can regain full consciousness [4], in some cases even years after the injury [5]. However, a variable but substantial proportion of patients with pDoC (even up to 74%) [4] die within 12 months of brain injury, most often due to severe medical complications such as pneumonia or cardiac failure, with lowest mortality rates following trauma [6][7][8].…”

Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

“…The selected studies included an overall sample of 2844 patients with disorders of consciousness (eight in coma, 0.3%; 1774 in VS/UWS, 62.4%; 926 in MCS, 32.6%; 136 having emerged from MCS [eMCS], 4.7%) caused by different aetiologies (traumatic brain injury 992, 34.9%; non‐traumatic brain injury 1852, 65.1%), with a mean age of 48 years (not available in two studies); 1825 (64.2%) patients were male (not available in one study). Most studies [3, 5, 13–19, 21, 23, 24, 26, 31, 32, 35, 36, 39, 40] investigated the prognostic role of demographic, clinical and anamnestic factors. Some studies also included neurophysiological [5, 16, 19, 20, 22, 23, 25, 28, 30, 32, 33, 38] or neuroimaging [15, 26, 29, 37–39] investigations.…”

“…The details of the included studies are reported in Table S1. Most studies [3,5,14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] enrolled patients in Europe (23/30, 77%), whereas five studies [15,[36][37][38][39] (16%) included patients from China, and two studies [13,40] (7%) included patients from the Americas.…”

¿Es proporcionado suspender la nutrición e hidratación artificial en pacientes con pronóstico incierto?

“…No obstante, el pronóstico de pacientes traumáticos sí es mejor, aunque la evidencia es de confianza baja a moderada en poblaciones adultas y pediátricas (17). Noé et al (18) siguieron a cien pacientes con síndrome de vigilia sin respuesta durante 132 +/-85 días, encontrando que cerca de un tercio de los pacientes progresaron hacia un estado de consciencia mínima y cerca de un décimo de ellos emergieron de este estado.…”